Home > Heart Surgery Blog > Bicuspid Aortic Valve > "Have The Guidelines For Replacing Aortic Aneurysms Changed For Patients With Bicuspid Aortic Valves?" Asks Barbara

"Have The Guidelines For Replacing Aortic Aneurysms Changed For Patients With Bicuspid Aortic Valves?" Asks Barbara

Written By: Adam Pick, Patient Advocate, Author & Website Founder
Medical Expert: Thomas Gleason, MD, Asheville Heart, North Carolina
Page Last Updated: May 12, 2025

I just received a great question from Barbara about aortic aneurysms, bicuspid aortic valves and the guidelines used by physicians to determine treatment. In her email, Barbara wrote to me, "Hi Adam - I have a bicuspid aortic valve with stenosis. I also have an aneurysm (4.1 cm) that we have been tracking for a number of years. I have heard that the guidelines for treatment just changed from 5cm to 4.5cm. Is that true? If so, why did the guidelines change? Is this change causing more patients, like me, to get treatment earlier? Thanks, Barbara"

Ascending aortic aneurysm and coronary artery button on heart drawing

Diagram Showing An Aortic Aneurysm

Barabara raises a great question considering so many patients in our community experience valvular disorders and aortic aneurysms simultaneously.

For that reason, I contacted Dr. Thomas Gleason.

Dr. Thomas Gleason - Heart Surgeon

In his response to Barbara's question, Dr. Gleason shared the following, "The short answer to Barbara's question is no, with one caveat. The recommended trigger point to treat an ascending aortic aneurysm in the setting of a bicuspid aortic valve remains 5.0 cm except among patients with a strong family history (first degree relatives) of aortic dissection for which the recommended diameter for surgical intervention is 4.5 cm. This is a minority of patients."

Dr. Gleason then provided additional insights for patients needing bicuspid aortic valve treatment who may need an aortic aneurysm procedure in the future. "For patients undergoing cardiac surgery for a valvular or other indication who incidentally also have a bicuspid valve and associated ascending aortic dilatation, it is reasonable to replace the ascending aorta at the time of the valve or other cardiac surgery to minimize the need for a reoperation later in life. These guidelines were recently published in the Annals of Thoracic Surgery (Ann Thorac Surg 2013;95:1491–505.) -- Best regards, Dr. Gleason"

I hope this helped Barbara (and perhaps you) learn more about the guidelines for aortic aneursym treatment for patient with valvular disorders including bicuspid aortic valves. Many thanks to Barbara for her question and a special thanks to Dr. Thomas Gleason for sharing his clinical experience and research with our community.

Written by Adam Pick - Patient & Website Founder

Adam Pick is a heart valve patient and author of The Patient's Guide To Heart Valve Surgery. In 2006, Adam founded HeartValveSurgery.com to educate and empower patients. This award-winning website has helped over 10 million people fight heart valve disease. Adam has been featured by the American Heart Association and Medical News Today.

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